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1.
Artigo em Inglês | MEDLINE | ID: mdl-33406601

RESUMO

Child survival and wellbeing remain a global health challenge despite vast development within the area and a significant decline in mortality rates of children under five years of age. This study investigates the perceived causes of ill health and childhood mortality in the context of five villages located in the Tonkolili district of Sierra Leone. Mixed method methodology was applied in this study consisting of both quantitative and qualitative data contribution. The quantitative part consisted of a household survey on child health, where 341 households, equivalent to 50.6% of the total number of households in the five villages, participated with a response rate of 100%. The qualitative part consisted of six semi structured interviews-one with a health care worker and five with mothers from each village. The main perceived reason for child morbidity was inadequate care of children related to personal hygiene of the child, hygiene and safety in the environment, in-sufficient nutrition, inadequate supervision and poor healthcare seeking behavior. Additionally, reasons given for disease included supernatural forces such as witchcraft. In relation to the survey, the perceived causes of child mortality for ill children in the villages were mainly malaria (33.6%), diarrhea (11.6%), pneumonia (8.6%), and unknown (26%). The observed symptoms of illness among children were fever (43.7%), cough and difficulty breathing (10.7%), frequent watery stool (10.3%) and no symptoms (20.3%). The perception of ill health in children was mainly associated with the parent's ability to cater for the child's physical needs, but also associated with external factors such as witchcraft and "God's will". In addition, biomedical causes for disease and supernatural causes for disease were seen to coexist.


Assuntos
Saúde da Criança , Mortalidade da Criança , Conhecimentos, Atitudes e Prática em Saúde , População Rural , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Higiene , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Serra Leoa/epidemiologia , Adulto Jovem
2.
PLoS Negl Trop Dis ; 14(12): e0008877, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33370270

RESUMO

BACKGROUND: Lymphatic filariasis (LF) is targeted for elimination in Sierra Leone. Epidemiological coverage of mass drug administration (MDA) with ivermectin and albendazole had been reported >65% in all 12 districts annually. Eight districts qualified to implement transmission assessment survey (TAS) in 2013 but were deferred until 2017 due to the Ebola outbreak (2014-2016). In 2017, four districts qualified for conducting a repeat pre-TAS after completing three more rounds of MDA and the final two districts were also eligible to implement a pre-TAS. METHODOLOGY/PRINCIPAL FINDINGS: For TAS, eight districts were surveyed as four evaluation units (EU). A school-based survey was conducted in children aged 6-7 years from 30 clusters per EU. For pre-TAS, one sentinel and one spot check site per district (with 2 spot check sites in Bombali) were selected and 300-350 persons aged 5 years and above were selected. For both surveys, finger prick blood samples were tested using the Filariasis Test Strips (FTS). For TAS, 7,143 children aged 6-7 years were surveyed across four EUs, and positives were found in three EUs, all below the critical cut-off value for each EU. For the repeat pre-TAS/pre-TAS, 3,994 persons over five years of age were surveyed. The Western Area Urban had FTS prevalence of 0.7% in two sites and qualified for TAS, while other five districts had sites with antigenemia prevalence >2%: 9.1-25.9% in Bombali, 7.5-19.4% in Koinadugu, 6.1-2.9% in Kailahun, 1.3-2.3% in Kenema and 1.7% - 3.7% in Western Area Rural. CONCLUSIONS/SIGNIFICANCE: Eight districts in Sierra Leone have successfully passed TAS1 and stopped MDA, with one more district qualified for conducting TAS1, a significant progress towards LF elimination. However, great challenges exist in eliminating LF from the whole country with repeated failure of pre-TAS in border districts. Effort needs to be intensified to achieve LF elimination.


Assuntos
Albendazol/uso terapêutico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Filaricidas , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Animais , Brugia Malayi/isolamento & purificação , Criança , Pré-Escolar , Erradicação de Doenças/métodos , Filariose Linfática/diagnóstico , Filariose Linfática/tratamento farmacológico , Filaricidas/uso terapêutico , Humanos , Serra Leoa/epidemiologia , Wuchereria bancrofti/isolamento & purificação
3.
BMJ Open ; 10(12): e038523, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323429

RESUMO

OBJECTIVES: Prevalence of cardiovascular disease risk factors (CVDRF) is increasing, especially in low-income countries. In Sierra Leone, there are no previous studies on the knowledge and the awareness of these conditions in the community. This study aimed to explore the knowledge and understanding of CVDRF, as well as the perceptions of the barriers and facilitators to accessing care for these conditions, among patients and community leaders in Sierra Leone. DESIGN: Qualitative study employing semistructured interviews and focus group discussions. SETTING: Urban and rural Bo District, Sierra Leone. PARTICIPANTS: Interviews with a purposive sample of 37 patients and two focus groups with six to nine community leaders. RESULTS: While participants possessed general knowledge of their conditions, the level and complexity of this knowledge varied widely. There were clear gaps in knowledge regarding the coexistence of CVDRF and their consequences, as well as the link between behavioural factors and CVDRF. An overarching theme from the data was the need to create an understanding and awareness of CVDRF in the community in order to prevent and improve management of these conditions. Cost was also seen as a major barrier to accessing care for CVDRFs. CONCLUSIONS: The knowledge gaps identified in this study highlight the need to design strategies and interventions that improve knowledge and recognition of CVDRF in the community. Interventions should specifically consider how to develop and enhance awareness about CVDRF and their consequences. They should also consider how patients seek help and where they access it.


Assuntos
Doenças Cardiovasculares , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Pesquisa Qualitativa , Fatores de Risco , Serra Leoa/epidemiologia
4.
BMC Med ; 18(1): 405, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33342436

RESUMO

BACKGROUND: Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. METHODS: We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. RESULTS: We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. CONCLUSIONS: Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.


Assuntos
Diarreia/terapia , Hidratação , Política de Saúde/tendências , Administração Oral , Bicarbonatos/uso terapêutico , Criança , Mortalidade da Criança/história , Mortalidade da Criança/tendências , Pré-Escolar , Diarreia/epidemiologia , Feminino , Hidratação/história , Hidratação/métodos , Hidratação/estatística & dados numéricos , Hidratação/tendências , Glucose/uso terapêutico , Política de Saúde/história , História do Século XX , História do Século XXI , Humanos , Lactente , Masculino , Mali/epidemiologia , Cloreto de Potássio/uso terapêutico , Senegal/epidemiologia , Índice de Gravidade de Doença , Serra Leoa/epidemiologia , Cloreto de Sódio/uso terapêutico , Análise Espacial , Fatores de Tempo , Resultado do Tratamento
5.
PLoS Negl Trop Dis ; 14(7): e0008496, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32735587

RESUMO

BACKGROUND: The unprecedented 2013/16 outbreak of Zaire ebolavirus (Ebola virus) in West Africa has highighted the need for rapid, high-throughput and POC diagnostic assays to enable timely detection and appropriate triaging of Ebola Virus Disease (EVD) patients. Ebola virus is highly infectious and prompt diagnosis and triage is crucial in preventing further spread within community and healthcare settings. Moreover, due to the ecology of Ebola virus it is important that newly developed diagnostic assays are suitable for use in both the healthcare environment and low resource rural locations. METHODOLOGY/PRINCIPLE FINDINGS: A LAMP assay was successfully developed with three detection formats; a real-time intercalating dye-based assay, a real-time probe-based assay to enable multiplexing and an end-point colourimetric assay to simplify interpretation for the field. All assay formats were sensitive and specific, detecting a range of Ebola virus strains isolated in 1976-2014; with Probit analysis predicting limits of detection of 243, 290 and 75 copies/reaction respectively and no cross-detection of related strains or other viral haemorrhagic fevers (VHF's). The assays are rapid, (as fast as 5-7.25 mins for real-time formats) and robust, detecting Ebola virus RNA in presence of minimally diluted bodily fluids. Moreover, when tested on patient samples from the 2013/16 outbreak, there were no false positives and 93-96% of all new case positives were detected, with only a failure to detect very low copy number samples. CONCLUSION/SIGNIFICANCE: These are a set of robust and adaptable diagnostic solutions, which are fast, easy-to-perform-and-interpret and are suitable for use on a range of platforms including portable low-power devices. They can be readily transferred to field-laboratory settings, with no specific equipment needs and are therefore ideally placed for use in locations with limited resources.


Assuntos
Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/virologia , Técnicas de Amplificação de Ácido Nucleico/métodos , Surtos de Doenças , Doença pelo Vírus Ebola/sangue , Doença pelo Vírus Ebola/epidemiologia , Humanos , RNA Viral , Sensibilidade e Especificidade , Serra Leoa/epidemiologia
6.
PLoS Negl Trop Dis ; 14(8): e0008624, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810138

RESUMO

BACKGROUND: Sierra Leone experienced the largest documented epidemic of Ebola Virus Disease in 2014-2015. The government implemented a national tollfree telephone line (1-1-7) for public reporting of illness and deaths to improve the detection of Ebola cases. Reporting of deaths declined substantially after the epidemic ended. To inform routine mortality surveillance, we aimed to describe the trends in deaths reported to the 1-1-7 system and to quantify people's motivations to continue reporting deaths after the epidemic. METHODS: First, we described the monthly trends in the number of deaths reported to the 1-1-7 system between September 2014 and September 2019. Second, we conducted a telephone survey in April 2017 with a national sample of individuals who reported a death to the 1-1-7 system between December 2016 and April 2017. We described the reported deaths and used ordered logistic regression modeling to examine the potential drivers of reporting motivations. FINDINGS: Analysis of the number of deaths reported to the 1-1-7 system showed that 12% of the expected deaths were captured in 2017 compared to approximately 34% in 2016 and over 100% in 2015. We interviewed 1,291 death reporters in the survey. Family members reported 56% of the deaths. Nearly every respondent (94%) expressed that they wanted the 1-1-7 system to continue. The most common motivation to report was to obey the government's mandate (82%). Respondents felt more motivated to report if the decedent exhibited Ebola-like symptoms (adjusted odds ratio 2.3; 95% confidence interval 1.8-2.9). CONCLUSIONS: Motivation to report deaths that resembled Ebola in the post-outbreak setting may have been influenced by knowledge and experiences from the prolonged epidemic. Transitioning the system to a routine mortality surveillance tool may require a robust social mobilization component to match the high reporting levels during the epidemic, which exceeded more than 100% of expected deaths in 2015.


Assuntos
Epidemias , Doença pelo Vírus Ebola/mortalidade , Vigilância da População , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Serra Leoa/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Adulto Jovem
7.
Ann Epidemiol ; 49: 68-74, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763341

RESUMO

PURPOSE: Sierra Leone recorded the highest incidence rate for the 2013-2016 West African Ebola outbreak. In this investigation, we used the medical records of Ebola patients with different sociodemographic and clinical features to determine the factors that are associated with Ebola treatment outcome during the 2013-2016 West African Ebola outbreak in Sierra Leone and constructed a predictive in-facility mortality score. METHODS: We used the anonymized medical records of 1077 laboratory-confirmed pediatric and adult patients with EVD who received treatment at the 34 Military Hospital and the Police Training School Ebola Treatment Centers in Sierra Leone between the period of June 2014 and April 2015. We later determined the in-facility case fatality rates for Ebola, the odds of dying during Ebola treatment, and later constructed a predictive in-facility mortality score for these patients based on their clinical and sociodemographic characteristics. RESULTS: We constructed a model that partitioned the study population into three mortality risk groups of equal patient numbers, based on risk scoring: low (score ≤ -5), medium (score -4 to 1), and high-risk group (score ≥ 2). The CFR of patients with EVD belonging to the low- (≤-5), medium (-4 to 1), and high- (≥2) risk groups were 0.56%, 9.75%, and 67.41%, respectively. CONCLUSIONS: We succeeded in designing an in-facility mortality risk score that reflects EVD clinical severity and can assist in the clinical prioritization of patients with EVD.


Assuntos
Doença pelo Vírus Ebola/terapia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Surtos de Doenças , Epidemias , Feminino , Instalações de Saúde , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Serra Leoa/epidemiologia , Fatores Socioeconômicos , Resultado do Tratamento , Adulto Jovem
8.
Am J Trop Med Hyg ; 103(5): 2142-2148, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32840199

RESUMO

A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and high-dependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week; 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21; 95% CI: 1.48-7.01; P = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs) OEWS (OR: 3.66; 95% CI: 1.15-16.96; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P ≤ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in the HDU was frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.


Assuntos
Cuidados Críticos/organização & administração , Estado Terminal/epidemiologia , Adulto , Estado Terminal/mortalidade , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Obstetrícia , Admissão do Paciente , Gravidez , Estudos Retrospectivos , Fatores de Risco , Serra Leoa/epidemiologia , Adulto Jovem
10.
PLoS One ; 15(7): e0236358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706810

RESUMO

BACKGROUND/SETTING: Only 47% of HIV-positive Sierra Leoneans knew their status in 2017, making expanded HIV testing a priority. National guidelines endorse provider-initiated HIV testing and counselling (PITC) to increase testing coverage, but PITC is rarely provided in Sierra Leone. In response, a Quality Improvement Collaborative (QIC) was implemented to improve PITC coverage amongst adult inpatients. METHODS: Ten hospitals received the intervention between October 2017 and August 2018; there were no control facilites. Each hospital aimed to improve PITC coverage to ≥ 95% of eligible patients. Staff received training on PITC and QIC methods and a package of PITC best practices and tools. They then worked to identify additional contextually-appropriate interventions, conducted rapid tests of change, and tracked performance using shared indicators and time-series data. Supportive supervision bolstered QI skills, and quarterly meetings enabled diffusion of innovations while spurring friendly competition. RESULTS: Baseline PITC coverage was 4%. The hospital teams tested diverse interventions using QI methods, including staff training; data review meetings; enhanced workflow processes and supervision; and patient education and sensitization activities Nine hospitals reached and sustained the 95% target, and all saw rapid and durable improvement, which was sustained for a median of six months. Of the 5,238 patients tested for HIV, 311 (6%) were found to be HIV-positive and were referred for treatment. HIV rapid test kit stockouts occurred during the project period, limiting PITC services in some cases. CONCLUSIONS: The intervention led to swift and sustained improvement in inpatient PITC coverage and to the diagnosis of hundreds of people living with HIV. Sierra Leone's Ministry of Health and Sanitation plans to take the initiative to national scale, with close attention to the issue of test kit stockouts.


Assuntos
Aconselhamento Diretivo/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Cooperação do Paciente/estatística & dados numéricos , Feminino , HIV-1 , Humanos , Pacientes Internados , Masculino , Serra Leoa/epidemiologia
11.
Public Health ; 185: 270-274, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32707469

RESUMO

OBJECTIVE: The aim of this study was to examine New Jersey Sierra Leoneans' experiences, perceptions, and knowledge about the Ebola outbreak to better understand how to serve diaspora communities during disease outbreaks and improve international community engagement efforts. STUDY DESIGN: Five focus groups were conducted with a total of 34 members of a New Jersey Sierra Leonean community. A short demographic survey was also administered. METHODS: Focus groups were audio-taped, transcribed, and then analyzed using QSR NVIVO. Demographic data were analyzed using SPSS. RESULTS: Major themes emerged from the focus groups as related to the Ebola outbreak: (1) stigma and discrimination; (2) psycho-socio-economic impact; and (3) public health communication challenges. CONCLUSIONS: Novel findings reveal the impact of the Ebola virus on a West African diaspora community in the United States. These findings also advance existing literature. Diaspora communities are an underutilized resource in international disease education, management and prevention outreach research. It is vital that health professionals begin to find effective ways to fold them into relief efforts.


Assuntos
Atitude Frente a Saúde , Ebolavirus , Doença pelo Vírus Ebola/epidemiologia , Migração Humana , Adulto , Idoso , Comunicação , Participação da Comunidade , Surtos de Doenças/prevenção & controle , Feminino , Grupos Focais , Doença pelo Vírus Ebola/psicologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Saúde Pública/educação , Serra Leoa/epidemiologia , Estigma Social , Estados Unidos/epidemiologia
12.
PLoS One ; 15(6): e0235108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579602

RESUMO

BACKGROUND: Concern has been expressed over how well Africa is prepared to cope with the pandemic of Covid-19. Will rural populations with low levels of education know how to apply community-based infection control? We undertook fieldwork in two villages in central Sierra Leone to gain insight into how rural people faced with Covid-19 assess epidemic infection risks. METHODS: Two communities were selected based on prior contrasted exposure to Ebola Virus Disease-one with substantial number of cases and the other having resisted infection through strong community sequestration measures. We assessed understanding of infection risks via an experimental game. This asked players to express a preference for one of two diseases, one resembling Ebola with lower risk of infection and the other resembling Covid-19 with lower risk of death. Players were not told the identity of the diseases. RESULTS: In total 107 adult villagers played the game (58% women). Half (52%) preferred the disease model with lower risk of infection, 29% preferred the model with lower risk of death, while 21% saw the combined risk of infection and death as being equivalent. Differences in reactions between the two locations were small despite different experiences of Ebola. Asked to explain their choices 48% of players cited information on infection risks modelled by the game and 31% stated that their choices reflected awareness of the need for personal action and respect for local regulations. We concluded that villagers thoughtfully assess disease risks and that some are good intuitive statisticians. CONCLUSIONS: Results suggest rural people in Sierra Leone retain the lessons of experience from the Ebola outbreak of 2014-15 and will be able to apply these lessons to a new infectious disease for which have no prior practical experience. Our expectation is that rural populations will understand Covid-19 control measures, thus reducing need for draconian enforcement.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Atitude Frente a Saúde , Tomada de Decisões , Feminino , Doença pelo Vírus Ebola/epidemiologia , Humanos , Masculino , Pandemias , Jogos e Brinquedos , Risco , População Rural , Serra Leoa/epidemiologia
13.
Ann Epidemiol ; 46: 1-4, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32532366

RESUMO

PURPOSE: Organizations responding to the 2014-2016 Ebola epidemic in Sierra Leone collected information from multiple sources and kept it in separate databases, including distinct data systems for Ebola hot line calls, patient information collected by field surveillance officers, laboratory testing results, clinical information from Ebola treatment and isolation facilities, and burial team records. METHODS: After the conclusion of the epidemic, the Sierra Leone Ministry of Health and Sanitation and the U.S. Centers for Disease Control and Prevention partnered to collect these disparate records and consolidate them in the Sierra Leone Ebola Database. RESULTS: The Sierra Leone Ebola Database data are providing a lasting resource for postepidemic data analysis and epidemiologic research, including identifying best strategies in outbreak response, and are used to help families locate the graves of family members who died during the epidemic. CONCLUSION: This report describes the Ministry of Health and Sanitation and Centers for Disease Control and Prevention processes to safeguard Ebola records while making the data available for public health research.


Assuntos
Gerenciamento de Dados/ética , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Disseminação de Informação/ética , Armazenamento e Recuperação da Informação/ética , Epidemias , Humanos , Privacidade , Saúde Pública , Serra Leoa/epidemiologia
14.
BMC Public Health ; 20(1): 855, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503478

RESUMO

BACKGROUND: Immunization of women during pregnancy to protect them and their infants against tetanus, pertussis and influenza is recommended by the World health Organization (WHO). However, there is limited information about the coverage rate and associated factors in low-income countries. The aim of this study was to measure the prevalence and predictors of taking tetanus toxoid among pregnant women in Sierra Leone. METHODS: This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2017. In total 8722 women aged between 15 and 49 years were included in this study. Outcome variable was taking of Tetanus Toxoid vaccination during the last pregnancy. Data were analyzed using cross-tabulation and logistic regression methods. RESULTS: The overall prevalence of receiving TT immunization during women's last pregnancy was 96.3% and that of taking at least two doses was 82.12%. In the regression analysis, women from Mende ethnicity had a 0.48 fold lower chance of being immunized (OR = 0.480, 95% CI = 0.385,0.59768) than those from the other ethnicity. In addition, women who attended at least four ANC visits had higher odds of receiving TT vaccine (OR = 1.919, 95% CI = 1.639,2.245) compared to those who attended less ANC visits. Stratified by areas, this association was observed in both urban (OR = 2.661, 95% CI = 1.924,3.679) and rural areas (OR = 1.716, 95% CI = 1.430,2.059). Attending at least four ANC visits showed a positive association with receiving at least two doses TT (OR = 2.434, 95% CI = 1.711,3.464) in both urban (OR = 2.815, 95% CI = 1.413,5.610) and rural areas (OR = 2.216, 95% CI = 1.463,3.356) as well. CONCLUSION: Higher number of ANC visits, mass media exposure and higher wealth quintile increased the odds of receiving TT immunization. In addition, minimum two doses which were identified to reduce neonatal mortality. Therefore, immunization campaigns targeting improved utilization of healthcare and immunization services by women of childbearing age in Sierra Leone are strongly recommended.


Assuntos
Cuidado Pré-Natal/estatística & dados numéricos , Toxoide Tetânico/administração & dosagem , Tétano/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Pobreza/estatística & dados numéricos , Gravidez , Prevalência , Serra Leoa/epidemiologia , Inquéritos e Questionários , Tétano/mortalidade , Adulto Jovem
15.
Int J Equity Health ; 19(1): 88, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503547

RESUMO

BACKGROUND: Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country. METHODS: The data for the study were derived from two rounds of the Sierra Leone Demographic and Health Survey conducted in 2008 and 2013, and two rounds of the Sierra Leone Multiple Indicator Cluster Survey done in 2005 and 2010. We used the 2019 update WHO Health Equity Assessment Toolkit (HEAT) to do the analysis. The toolkit makes use of data stored in the WHO Health Equity Monitor database. We analyzed stunting inequality using summary measures: Population Attributable Risk, Population Attributable Fraction, Difference and Ratio. The summary measures were computed for five equity stratifers: wealth, education, child's sex, place of residence and subnational region. We computed 95% Confidence Interval (CI) for each point estimate to show whether or not observed stunting inequalities are statistically significant, and whether or not the disparity changed over time statistically significantly. RESULTS: The findings demonstrated stark inequalities in stunting in all the studied dimensions of inequality. While residence and subnational regional related inequalities remain unchanged over time, wealth and educational inequality had seen slight improvement during the same time period. Large sex related stunting inequality remained during the first three surveys time points, but it disappeared in 2013. CONCLUSIONS: Huge stunting disparities occurred in Sierra Leone, and the disparity disproportionately affects disadvantaged subpopulations and male children. Nutrition interventions that specifically target the subgroups which suffer more from the burden of stunting are required.


Assuntos
Transtornos do Crescimento/epidemiologia , Disparidades nos Níveis de Saúde , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Serra Leoa/epidemiologia , Fatores Socioeconômicos
16.
PLoS Negl Trop Dis ; 14(5): e0008256, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32437345

RESUMO

INTRODUCTION: In public health emergencies, local media are important sources of information for the public. Not much is known about the professional and personal roles and experiences of Sierra Leonean journalists during the Ebola virus disease (EVD) outbreak between 2014-2015. METHODS/PRINCIPAL FINDINGS: This qualitative study is based on semi-structured interviews with 13 Sierra Leonean journalists based in urban Freetown and rural Waterloo in February and March 2016. The majority of the journalists worked for radio stations. The mostly male journalists represented national, regional and local radio stations. Transcripts of the interviews were analysed using thematic analysis. The analysis was inspired by previously reported journalist roles and agenda-setting theory, which state that the media filter what is happening, making a few core issues more salient. Sierra Leonean journalists shifted from being sceptical monitors in the beginning of the outbreak, to collaborative instructors towards the end. While they adapted to different roles, journalists struggled with their own fears for the virus, which hampered their work. They indicated that the training they received about Ebola helped them overcome their fear. Being trained gave a sense of security that helped them carry out their jobs. By turning into instructors, journalists stepped away from their journalistic professional detachment-potentially exacerbated by their personal experiences. CONCLUSION/SIGNIFICANCE: The first months of the outbreak were marked by passive agenda-setting roles of Sierra Leonean journalists. It took several months before the outbreak became a core issue in local media. In health emergencies, efforts should be made to partner with local media to use their platforms for local, trusted journalists and leaders to disseminate public health messages. Whereas this might hamper journalists' credibility and can be challenging in areas with problematic press freedom, Sierra Leonean journalists experienced the outbreak as a driver of necessary change in their profession.


Assuntos
Atitude Frente a Saúde , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Disseminação de Informação/métodos , Jornalismo Médico , Adulto , Feminino , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Serra Leoa/epidemiologia
17.
Int J Infect Dis ; 97: 167-173, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32450292

RESUMO

BACKGROUND: Between December 2013 and June 2016, West Africa experienced the largest Ebola virus disease (EVD) outbreak in history. Understanding EVD in pregnancy is important for EVD clinical screening and infection prevention and control. METHODS: We conducted a review of medical records and EVD investigation reports from three districts in Sierra Leone. We report the clinical presentations and maternal and fetal outcomes of six pregnant women with atypical EVD, and subsequent transmission events from perinatal care. RESULTS: The six women (ages 18-38) were all in the third trimester. Each presented with signs and symptoms initially attributed to pregnancy. None met EVD case definition; only one was known at presentation to be a contact of an EVD case. Five women died, and all six fetuses/neonates died. These cases resulted in at least 35 additional EVD cases. CONCLUSIONS: These cases add to the sparse literature focusing on pregnant women with EVD, highlighting challenges and implications for outbreak control. Infected newborns may also present atypically and may shed virus while apparently asymptomatic. Pregnant women identified a priori as contacts of EVD cases require special attention and planning for obstetrical care.


Assuntos
Doença pelo Vírus Ebola/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Adolescente , Adulto , Surtos de Doenças , Feminino , Doença pelo Vírus Ebola/epidemiologia , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/virologia , Saúde Pública , Serra Leoa/epidemiologia , Adulto Jovem
18.
Pan Afr Med J ; 35(Suppl 1): 8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32373259

RESUMO

Introduction: Guinea, Sierra Leone and Liberia have attained significant reduction in measles incidence between 2004 and 2013. The Ebola outbreak in 2014-2015 in West Africa caused significant disruption of the health service delivery in the three worst affected countries. The magnitude of the impact on the immunization program has not been well documented. Methods: We reviewed national routine immunization administrative coverage data as well as measles surveillance performance and measles epidemiology in the years before, during and after the EVD outbreak in Guinea, Liberia, Sierra Leone. Results: Both Liberia and Guinea experienced a sharp decline of more than 25% in the monthly number of children vaccinated against measles in 2014 and 2015 as compared to the previous years, while there was no reported decline in Sierra Leone. Guinea and Liberia experienced a decline in measles surveillance activity and performance indicators in 2014 and 2015. During this period, there was an increase in measles incidence and a decline in the mean age of measles cases reported in Liberia and Sierra Leone. Guinea started reporting high measles incidence in 2016. All three countries organized measles supplemental immunization activities by June 2015. Liberia achieved 99% administrative coverage, while Guinea and Sierra Leone attained 90.6% and 97.2% coverage respectively. There were no severe adverse events reported during these mass vaccination activities. The disruptive effect of the Ebola outbreak on immunization services was especially evident in Guinea and Liberia. Our review of the reported administrative vaccination coverage at national level does not show significant decline in measles first dose vaccination coverage in Sierra Leone as compared to other reports. This may be due to inaccuracies in coverage monitoring and data quality problems. The increases in measles transmission and incidence in these three countries can be explained by the rapid accumulation of susceptible children. Despite the organization of mass vaccination activities, measles incidence through 2017 has remained higher than the pre-Ebola period in all three countries. Conclusion: The Ebola outbreak in West Africa significantly affected measles vaccination coverage rates in two of the three worst affected countries, and led to persistent gaps in coverage, along with high measles incidence that was documented until two years after the end of the Ebola outbreak. Liberia and Sierra Leone have demonstrated coverage improvements after the end of the Ebola outbreak.


Assuntos
Erradicação de Doenças/organização & administração , Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Programas de Imunização/organização & administração , Sarampo/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Criança , Pré-Escolar , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Erradicação de Doenças/métodos , Erradicação de Doenças/normas , Guiné/epidemiologia , Humanos , Programas de Imunização/normas , Programas de Imunização/estatística & dados numéricos , Lactente , Libéria/epidemiologia , Vacinação em Massa/organização & administração , Vacinação em Massa/normas , Vacinação em Massa/estatística & dados numéricos , Sarampo/epidemiologia , Vigilância da População , Estudos Retrospectivos , Serra Leoa/epidemiologia , Cobertura Vacinal/organização & administração , Cobertura Vacinal/normas
20.
Int J Infect Dis ; 96: 112-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32339724

RESUMO

OBJECTIVE: To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS: A retrospective study was conducted of adult TB patients aged ≥15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS: Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p=0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p=0.001) were independent predictors of mortality. CONCLUSIONS: Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.


Assuntos
Tuberculose/diagnóstico , Tuberculose/terapia , Adolescente , Adulto , Idoso , Cidades , Coinfecção/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Serra Leoa/epidemiologia , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/mortalidade , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
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